Menopause is a normal part of life. It is one step in a long, slow process of reproductive aging. For most women this process begins silently somewhere around age 40 when periods may start to be less regular. Declining levels of the hormones estrogen and progesterone cause changes in your periods. These hormones are important for keeping the vagina and uterus healthy as well as for normal menstrual cycles and for successful pregnancy. Estrogen also helps to keep bones healthy. It helps women keep good cholesterol levels in their blood.

Some types of surgery can bring on menopause. For instance, removal of your uterus (hysterectomy) will make your periods stop. When both ovaries are removed (oophorectomy), menopause symptoms may start right away, no matter what your age.

In perimenopause, your doctor might suggest birth control pills especially if you are having problems with very heavy, frequent or unpredictable menstrual periods. This medication will make your periods more regular. It may also help with symptoms like hot flashes. However, birth control pills can hide the arrival of menopause. If you think you might have reached menopause, you can stop taking the pill for a while and see if you start having regular periods again. But if you were using birth control pills to prevent pregnancy, you should remember to use another type of contraceptive until you have gone 12 months without a period.

In menopause, your doctor might suggest taking estrogen and progesterone, known as hormone replacement therapy or HRT. HRT involves taking estrogen plus progestin. Estrogen alone, or ERT, is for women who have had the uterus removed. Estrogen plus

progestin is for women with a uterus. Progestin, when used with estrogen, helps reduce the risk of uterine cancer. These hormones can be taken in a variety of forms such as pills, skin patches, creams, or vaginal inserts, depending on a woman’s needs.

HRT or ERT may relieve menopause-related symptoms, such as hot flashes, and reduce loss of bone. However, HRT has risks. It should not be used for long-term prevention of heart disease. Taking HRT increases, rather than reduces, the risk for heart disease and stroke. It also increases the risk of breast cancer and blood clots. But it appears

to decrease the risk of colon cancer. Scientists are still studying the effects of HRT — the final answers are not yet available. Talk to your doctor about taking estrogen/progestin

or about other treatments (for example, biofeedback) that may ease menopausal symptoms

Talk to your doctor to decide how to best manage your menopause. Think about your symptoms and how much they bother you. You also need to consider your medical history – your risk of heart disease, osteoporosis, and breast cancer. Remember that your decisions are never final. You can, and should, review them with your doctor every year during your checkup. You can see a gynecologist, geriatrician, general practitioner, or internist.

For your grandmother and great-grandmother, life expectancy was shorter. Reaching menopause often meant that their life was nearing an end. But this is no longer true. Today women are living longer — on average, until age 78. By making wise decisions about menopause and a healthy lifestyle, you can make the most of the 20, 30, or more years you have ahead!